Provider Demographics
NPI:1740641695
Name:SILVER LAKE SUPPORT SERVICES
Entity type:Organization
Organization Name:SILVER LAKE SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AVRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC
Authorized Official - Phone:718-815-3155
Mailing Address - Street 1:201 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2763
Mailing Address - Country:US
Mailing Address - Phone:718-815-3155
Mailing Address - Fax:
Practice Address - Street 1:201 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2763
Practice Address - Country:US
Practice Address - Phone:718-815-3155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY576942811251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health